Background. Estrogen and progesterone receptor status can predict breast cancer patient prognosis and treatment sensitivity, but research on low ER and PR levels and expression balance remains limited. Methods. From January 2010 to October 2016, 283 ER+/PR+/HER2-breast cancer patients who met the inclusion criteria were enrolled and divided into the H group (ER > 10%, N = 261) and the L group (1% ≤ ER ≤ 10%, N = 22). Groups were further divided into the HH group (ER > 10%/PR > 20%, N = 201), the HL group (ER > 10%/ER 1% ≤ PR ≤ 20% PR, N = 60), the LH group (1% ≤ ER ≤ 10%/PR > 20%, N = 5), and the LL group (1% ≤ ER ≤ 10%/1% ≤ PR ≤ 20%, N = 17). The LH group was excluded due to its small size, leaving the clinical and prognostic characteristics of 2 large groups and 3 subgroups to be analyzed. Results. L group patients had significantly more stage N2 axillary lymph nodes than H group patients (31.8% vs. 9.2%, P  = 0.007). Age ( P  = 0.011), menopause status ( P  = 0.001), and tumor size ( P  = 0.024) were significantly different in the HL vs. HH and LL groups. Five-year DFS (94.6% vs. 77.0%, P  < 0.001) and 5-year OS (97.2% vs. 85.8%, P  = 0.001) rates significantly differed between HH and HL. No significant differences in 5-year DFS (77.0% vs. 81.9%, P  = 0.564) or 5-year OS (85.8% vs. 87.8%, P  = 0.729) rates were observed between HL and LL; the OS rates of HL and LL were similar. Conclusion. In the group of ER+/PR+/HER2-patients, there was no significant prognostic difference between ER-low positive and ER-high positive groups, but low PR expression was significantly associated with a worse prognosis. The role of ER and PR balance in breast cancer progression and individualized treatment requires further investigation.

Neurofibromas predominately consist of Schwann cells and fibroblasts, which mainly originate from neurofibromatosis type 1. However, solitary cervical vagal nerve neurofibroma (VNN) has rarely been reported in previously published literature. Additionally, the onset of VNN is characteristically chronic, asymptomatic, and insidious, and is often discovered unexpectedly through physical examination or imaging. The exact etiology and pathogenesis of VNN are yet to be clarified and need further exploration.Consequently, the definitive diagnosis of VNN mainly depends on pathological and immunohistochemical examinations. Immunohistochemically, tumor cells are positive for transcription factor S-100, SRYrelated HMG-box (SOX)-10, and vascular marker CD34 will contribute to the diagnosis of VNN. In this uncommon case of left cervical VNN, the patient received comprehensive radiological evaluation before the operation and then underwent mass resection through endoscopic surgery via an axillary and chest wall approach. The patient was satisfied with the postoperative appearance of the neck. Besides, no postoperative complications or recurrence were observed during the consecutive six-month follow-up. Therefore, the successful application of total endoscopic surgery via the bilateral axilla-breast approach (BABA) on this case of neurogenic tumor presents new insights into expanding the operative indications of this technique, which could be a rational candidate for this kind of neck tumor with the requirements of satisfactory aesthetic appearance.

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A man suffered severe hypotension down to 20~30 mmHg when he received a surgical remove of glioma. This hypotension was hard to treat with many ways due to the blood pressure did not show any response to many vasoconstrictors, such as: adrenaline, norepinephrine, dopamine, and Aramine etc. A rapid injection of lidocaine 200 mg from right femoral vessel showed an efficient effect on promoting blood pressure when combined with other vasoconstrictors.